Dyschezia, or difficulty evacuating the bowel, is the most common gastrointestinal dysfunction in pregnancy, second only to nausea. It is defined as the presence of at least two symptoms of difficult bowel movements during at least 25% of defecations. Risk factors include increased age, high pre-pregnancy BMI, sedentary lifestyle, and stress. Hormonal changes in pregnancy, particularly increased progesterone levels, can slow intestinal transit time and inhibit smooth muscle contractility. Management involves lifestyle and dietary changes initially, with bulk-forming laxatives preferred for long-term use. Stimulant laxatives like senna provide faster relief and have not been shown to increase risks of malformations when used short-
In settings with limited access to health care, misoprostol is an important intervention that could reduce maternal deaths both directly and through the more cost-effective use of health services. Misoprostol is, however, a powerful drug that needs to be used with care. Evidence-based information about the safest regimens should be widely disseminated so as to prevent its inappropriate use
In settings with limited access to health care, misoprostol is an important intervention that could reduce maternal deaths both directly and through the more cost-effective use of health services. Misoprostol is, however, a powerful drug that needs to be used with care. Evidence-based information about the safest regimens should be widely disseminated so as to prevent its inappropriate use
Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually performed during second stage of labor to quickly enlarge the opening for the baby to pass through.
Role of progestogens in obstetrics and gynecologyAhmad Saber
The
different progestogens with their overlapping effects on estrogen, androgen, glucocorticoid,
and mineralocorticoid receptors are described in order to allow the clinician to make the most appropriate choice of progestogen.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
This presentation is made by taking help from RCOG Guideline about Obstetric Cholestasis.
To watch video about this presentation visit this YouTube link.
https://www.youtube.com/watch?v=gD7bN6zaLJU
Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually performed during second stage of labor to quickly enlarge the opening for the baby to pass through.
Role of progestogens in obstetrics and gynecologyAhmad Saber
The
different progestogens with their overlapping effects on estrogen, androgen, glucocorticoid,
and mineralocorticoid receptors are described in order to allow the clinician to make the most appropriate choice of progestogen.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
This presentation is made by taking help from RCOG Guideline about Obstetric Cholestasis.
To watch video about this presentation visit this YouTube link.
https://www.youtube.com/watch?v=gD7bN6zaLJU
Intrahepatic Cholestasis of Pregnancy - Prof Surekha TayadeSurekhaTayade4
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Improving women's diet quality preconceptionally and during gestation: Effect...POSHAN
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For more information about the conference visit our website: www.poshan.ifpri.info
Do you know that studies have shown that probiotics goes beyond gut health? Learn more from Dr. Anders Henriksson, Principal Application Specialist through his presentation at the Food for Health Conference held in conjunction with UMass 100th anniversary.
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Constipation is common health problem of youngsters and their cure is possible through change in food habits. Inclusion of dietary fibers in the diet reduces the constipation and its complications like overweight, cancer etc.
Case Study on Intrauterine Growth RestrictionAbhineet Dey
A clinically based study of a case of Intrauterine Growth Restriction (IUGR) or Foetal Growth Restriction (FGR).
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
42: Liza Hazarika
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
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Peripartum cardiomyopathy (PPCM) is a rare form of heart failure that occurs during the last month of pregnancy or within the first five months postpartum. It presents significant challenges in diagnosis and treatment due to its overlap with symptoms of normal pregnancy and postpartum changes. This condition varies in incidence across different racial groups and geographical locations, with a notable occurrence in the United States and southern India.
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After an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.
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This presentation focuses on a critical aspect of maternal care: "Reducing Maternal Mortality through Rapid Response in Obstetric Haemorrhage" (RRRR). As we navigate through this presentation, let us collectively work towards advancing our understanding and application of RRRR in obstetric care to safeguard the well-being of mothers during childbirth.
Anemia is a condition in which the number of red blood cells and/OR their oxy...Niranjan Chavan
Anemia is a condition in which the number of red blood cells and/OR their
oxygen-carrying capacity is insufficient to meet the body’s physiological needs.
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...Niranjan Chavan
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Here is a highly informative session on guidelines and identification of early sepsis as it is critical for timely intervention and improved patient outcomes.
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Today, we face new infectious threats; but also benefit from advanced diagnostics and treatments. Looking ahead, it’s crucial to continue
adapting to emerging pathogens, implement stringent preventive measures, and
leverage cutting-edge technologies to ensure the safety and well-being of our patients in the ever-evolving landscape of obstetrics and gynecology.
Vaccination during pregnancy is crucial to protect both the mother and the developing baby. It helps prevent serious complications and ensures a healthier start in life. #VaccinateForTwo 🤰💉
Explore a comprehensive presentation on Invasive Cervical Carcinoma, shedding light on its causes, symptoms, diagnosis, treatment options, and preventive measures.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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ASA GUIDELINE
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Dyschezia is the most common
gastrointestinal dysfunctions in pregnancy
….......... 2nd only to nausea2
1. Ghosal UC. Tropical Gastroenterology. 2007; July. Vol (28). Issue 3: 91-5.
2. Fan W. Int J Clin Exp Med 2020;13(3):2022-2026
Dyschezia – Difficulty in evacuating the bowel 1
3. 1. Fan W. Int J Clin Exp Med 2020;13(3):2022-2026. 2. Turawa
EB. Cochrane Database of Systematic Reviews 2015, Issue 9.
Art. No.: CD011625.DOI: 10.1002/14651858.CD011625.pub2 as
accessed on 14/10/21 3. Cooklin AR et al. BIRTH 42:3
September 2015). 254-59
Burden
4. Majority of Pregnant women
ROME III Criteria1
Presence of at least 2 of the 6
symptoms during at least 25% of
defecations
• 1. Body C. Gastroenterol Clin N Am 45 (2016) 267–283
5. RISK FACTORS
IN PREGNANCY
• Age
• Increases with age. High risks above 35
years
• Pre-pregnancy BMI
• Prevalence rate increased with pre-
pregnancy
• BMI >24 (27%); 18.5 – 24 (6.6%); < 18.5
(4.16%)
• Sedentary lifestyle
• Spicy food intake
• Stress
• Depression
• Threatened Abortion during early pregnancy
• Subsequent pregnancies
Shi W, Xu X, Zhang Y, Guo S, Wang J,
Wang J (2015) Epidemiology and Risk Factors of
Functional Constipation in Pregnant Women. PLoS
ONE 10(7): e0133521. doi:10.1371/journal
6. Etiology of Dyschezia in Pregnancy
Bonapace ES and Fischer R. Constipation and
Diarrhea in Pregnancy.Gastroenterology clinics of North
America. 1998 March. Volume 27.Issue 1: 197 – 211.
7. Delayed
Transit time
- Allow greater time for
the absorption of fluids
and electrolytes
- Hormonal changes
in pregnancy can cause
changes in intestinal
motility
• Role of Progesterone in causing dyschezia
• Inhibit gut smooth muscle
• Decrease esophageal, gastric and colonic muscle
contractility
• Decrease gastric motility and prolong gastric
emptying
• Alteration of Ca+2 flux across cell membrane
• Alter mechanical activity of colonic smooth muscle
and slow colonic transit
• Longer colonic transit time in women compared to
men as studied using radiopaque markers
• Slowest transit time during luteal phase of menstrual
cycle and third trimester of pregnancy
• Delay in the transit occur primarily when
progesterone levels increased from less than 1
ng/ml to 80 ng/ml
• Inhibits hormone MOTILIN responsible for stimulating
the smooth muscles of LES, stomach, small and large
intestines
Bonapace ES and Fischer R. Constipation and
Diarrhea in Pregnancy.Gastroenterology clinics of North
America. 1998 March. Volume 27.Issue 1: 197 – 211.
8. Resistance to
intestinal transit
• Mechanical Obstruction on
rectosigmoid
• Gravid Uterus
• Large Hemorrhoids
• Intestinal Obstructions due to
adhesion from prior surgeries
• Intestinal volvulus (25% o fthe
cases of mechanical
obstruction)
Bonapace ES and Fischer R. Constipation and
Diarrhea in Pregnancy.Gastroenterology clinics of North
America. 1998 March. Volume 27.Issue 1: 197 – 211.
9. Miscellaneous
Factors
• Oral Iron preparations
• Volitional suppression due to
psychological and environmental
stress
• Acute intestinal psuedo –
obstruction
• Tocolytic therapy with Mg and
Nifedipine for preterm labour
Bonapace ES and Fischer R. Constipation and
Diarrhea in Pregnancy.Gastroenterology clinics of North
America. 1998 March. Volume 27.Issue 1: 197 – 211.
10. Clinical Profile –
symptoms
Dyschezia Symptoms and Diagnoses
(by the Rome II Criteria)
Reported in Each Trimester and at 3 Months
Postpartum
(Obstet Gynecol 2007;110:1351–7)
• Majority of pregnant women –
• `Presence of abdominal pain and
bloating – Irritable bowel
syndrome
• First trimester – 19%
• Second trimester – 13%
• Third trimester – 13%
• 3 month of postpartum – 5%
• Straining or use of digital manipulation
and/or perineal pressure to facilitate
defecation – pelvic floor dysfunction
12. Impact in pregnant women
•
•
•
•
•
•
•
Shi W, Xu X, Zhang Y, Guo S, Wang J, Wang J (2015) Epidemiology and Risk Factors of Functional Constipation in Pregnant Women.
PLoS ONE 10(7): e0133521. doi:10.1371/journal. pone.0133521
16. BULK – FORMING AGENTS
• Retain fluid in the stool and increase stool weight and
consistency
•
•
•
•
Canadian Fam Phy. Aug 2012. Vol. 58 (*): 836 - 38
17. Stool Softeners
• Surface active agents lower surface tension, which leads to
water and fats penetrating the stool
•
•
Canadian Fam Phy. Aug 2012. Vol. 58 (*): 836 - 38
20. Stimulant Laxatives
• Stimulant laxatives stimulate the myenteric plexus and the
Auerbach plexus, which increase intestinal secretions and
motility
• They also decrease the absorption of water from the lumen of
the bowel
• They have poor bioavailability
• Senna does not appear to be associated with increased risk of
malformations
• Unpleasant side effects such as abdominal cramps ARE LESS
Canadian Fam Phy. Aug 2012. Vol. 58 (*): 836 - 38
22. Prokinetic Drugs
•
•
•
•
Cullen G and O’Donoghue D. Constipation and Pregnancy. Best Practice & Research Clinical Gastroenterology
2007 .Vol. 21, No. 5, pp. 807–818,
23. Summary of Laxatives
Laxatives Usual Daily
Dose
Pregnancy
Category
Comments
Bulk forming
Psyllium
6.4 – 10 g B Preferred in long term management. To be taken with large amount
of water (at least 8 oz). Abdominal bloating and flatulence
Lactulose 15 – 30 ml B May cause gas, abdominal bloating, long term use may be
associated with electrolyte imbalance. Cannot be preferred in
gestational diabetes patients
PEG 15 – 30 ml B Minimum systemic absorption. Same as above
Magnesium oxide 30 – 45 ml B Hypermagnesemia
Senna 7.5 – 30 mg C Faster onset of action . Senna was found to be effective in a short-
term treatment in pregnancy without any increased risk of
malformations
Bisacodyl 10 – 15 mg
orally or 10
mg per
rectum
C Abdominal cramps
Prather CM. Pregnancy related constipation. Curr Gastro Reports. 2004. 6:402 - 404
24. Senna in Pregnancy
• Animal studies
• No fetal risk
• No uterine stimulant activity
• Human studies
• 937 pregnant women treated with Senna preparations
• Treatment period range ( 2 weeks – 9 month)
• Good laxative efficacy with few side effects
• No uterine stimulant effect seen even in pregnancies with tendencies to
premature labor or bleeding during late pregnancy
• Prophylactic use to avoid undue straining
Pharmacology 1992;44:20–22
25. Senna Safety in Pregnancy: Risk of Congenital Anomalies
• Nandor Acs et al.
• Population based case control
Surveillance System of
Congenital Anomalies
(HCCSCA)
• 22843 cases of Congenital
Anomalies studied (1980 – 1996)
Among laxative drugs,
senna has no teratogenic
potential; thus, if severe,
requires laxative drug
treatment in pregnant
women, senna is not
contraindicated.
26. Safety of Laxatives – clinical studies
Senna has poor systemic bioavailability and local action with no increased risk
for malformations
836 Canadian Family Physician • Le Médecin de famille canadien | Vol 58: august • aoûT 2012
27. Cochrane Reviews 2015
• Rungsiprakarn P et al
• Senna is not associated with teratogenic effects and is
considered to be safe in pregnancy
• Compared with bulk-forming laxatives, Senna preparations led
to an improvement
Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011448. DOI: 10.1002/14651858.CD011448.pub2.
28. Senna use in Puerperium
• Shelton MG et al
• Double blind
randomized placebo
controlled trial
• 471 mothers treated
with Senna
preparations 7 mg two
tablets in the morning
or placebo for
maximum of 4 days
Shelton MG. S. Afr, med J., 57, 78 (1980)
Early postpartum bowel
actions
• Success rates of 93% white mothers
treated with Senna at day 1
• Success rates of 96% Colored
mothers treated with Senna at day 1
Assisted Vaginal Delivery
• 91% of women with assisted vaginal
deliveries treated with Senna had
bowel movements within 48 hours
Episiotomy and Perineal
tears
• 91% of women with assisted vaginal
deliveries treated with Senna had
bowel movements within 48 hours
No incidence of loose stools
in infants born to colored
mothers
29. Summary
• Dyschezia is the most common complaint in pregnancy and
postpartum women
• Education, lifestyle and dietary changes are initial steps in the
management
• In case of no relief, laxatives are prescribed
• Bulk forming are preferred for long term relief but it is slow acting
and associated with abdominal discomfort, bloating and flatulence
• Stimulant laxatives such as Senna are useful for short term relief
with no increased risk of congenital malformations